HMO medicine sets up an inevitable conflict between the physicians' traditional fiduciary role and the financial interests of the health plan and its physicians. Regulatory interventions, such as the formulation of rules regarding clinical practice, put government in a micromanagement role it...

The 1990's have seen an explosion of state legislation mandating the provision of specific health insurance benefits, and the federal government appears poised to enact significant managed care patient protection legislation as well. Although patient protection is popular with voters, economists...

U.S. Prison health care has recently been in the news and in the courts. A particular issue is whether prisons should contract out for health care. Contracting out has been growing over the past few decadest. The stated motivation for this change ranges from a desire to improve the prison health...

Markov-based and discrete event simulation models are widely used in health economic analysis to estimate the long term effects of treatment on clinical and economic outcomes. However, none of them simultaneously integrate patients' economic resources and their medical decision making in the...

Millions Saved (2016) is a new edition of detailed case studies on the attributable impact of global health programs at scale. As an input to the book, this paper provides an independent assessment of the cost-effectiveness of a selection of the cases using ex post information from impact...

The economic evaluation of health care programs can be carried out from two different perspectives: the hospital's narrow perspective and the social perspective, which includes all costs. It is well known that, depending on the perspective, the economic evaluation may lead to discrepant...

Cost-effectiveness analysis is versatile and used widely to assist in health care decision making. This chapter discusses how cost-effectiveness analysis is used at the system or national level, particularly in the domain of coverage and payment policy. We describe its relationship to other...

Publicly-funded health care is undergoing a paradigm shift as Medicaid converts from fee-for-service systems to managed care plans. This shift to capitated reimbursement affects the methods that women, including those with HIV, use to access primary health care and related specialty care. This...

This article examines issues potentially raised under the Americans with Disabilities Act (ADA) by states' decisions whether and how to include disabled Medicaid recipients in the massive shift towards Medicaid managed care. Part II briefly examines the special issues that disabled Medicaid...